Asbestos project notification and inspection report form

NYC 9/11 Public Portal Document

NYC DEPARTMENT OF ENVIRONMENTAL PROTECTION Asbestos Control Program 59-17 Junction Boulevard, 8„ Floor, Corona, NY 11368-5107 Building Dept. or TRU No ONLY 1 D~rP / ; FOR OFFICIAL USE ONLY 7YPEWR/7TEN /~ ASBESTOS PROJECT NOTIFICATION FORMS tA1LL BE rwT (ASBESTOS INSPECTION REPORT) ACCEPTED i -••.•.~.r••1••~ 1. /Caw faw of 1# Awl

When submitting this form at the NYC DepE signatures are required. Submittal at the t'

I. FACILITY form must be submitted to the NYC DEP not S~Ce~ 2. Address Yo aedVer oLreeL

AKA 56 Beaver Street

5. Type of Facility LC II. BUILDING OWNER V' aieLkA 7. Name Time Equities 9. Tel. # 212-206-5694 Fax# __ 10. Address

Ill. GENERAL CONTRACTOR

11. Name _ Tel. # IV. ASBESTOS ABATEMENT CONTRACTOR

12. Name Trio Asbestos Removal Corp. 13. Contact Person Chris Horan 14. Federal Employer ID. #!______P--______ 15. Tel. #718-961-41 00 Fax# 718-961-4103 16.Address_ 14-20 129th Street cityCollege Point State NY Zip 11 356 V. THIRD PARTY AIR MONITOR

17. Name Warren & Panzer Engineers, P.C. 18. Contact Person Michael Nolan 19. Federal Employer ID. # 20. Tel. # 21 2-922-0077 Fax# 212-922-0630 21.Address228 East 45th Street New York City State NY Zip 10017 22. Sample Analysis Laboratory Warren & Panzer Engineers 23. NYS DOH ELAP # 1 1 251:' VI. PROJECT INFORMATION 24. Starting date for this portion of work Projected completion date

Asbestos work schedule ❑ Monday ❑ Tuesday ❑ Wednesday 0 Thursday ❑ Friday ❑ Saturday ❑ Sunday

Shift from: ______Dam ❑pm to Dam ❑pm

If other, specify _

Access to inspect the premises must be provided during the work schedule indicated in this item.

25. Total amount of asbestos-containing material to be abated during this work

...J..,_250 _ Square Feet, and/or _ Linear Feet

7 I1

NYC-WTC 000111220